Medicare And Medicaid

The government plans a 'computer matching program' to combat improper Medicare, Medicaid payments

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The government plans to start a "computer matching program" to reduce improper payments from government health programs to providers and other entities, the Centers for Medicare & Medicaid Services announced in a memorandum Friday.

Profile: AHCA's money player

Profile: AHCA's money player

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If there's a prevailing theme around the hours American Health Care Association senior fellow Elise Smith keeps, it's that they are constant.

Hospitalist firm charged

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A hospitalist company that works with thousands of facilities is facing federal charges that its clinicians routinely overbilled Medicare and Medicaid, authorities recently announced.

Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find

Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find

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Elderly, frail people are more likely to be hospitalized if they are receiving home- or community-based services than if they live in a nursing home, according to newly published research. Recent Medicaid reforms have aimed to increase use of HCBS because it is believed to be less costly than institutional long-term care, investigators noted. They said their findings suggest that more frequent hospitalizations are a "hidden cost" of home- and community-based care.

Court expresses concern over Omnicare drug packaging practices but dismisses False Claims suit

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A whistleblower exposed disturbing drug packaging practices being used by long-term care pharmacy Omnicare Inc., but the charges don't fall under the False Claims Act, a federal appeals court recently ruled.

Feds join suit against hospitalist company

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The federal government has joined in a whistleblower lawsuit alleging that a large hospitalist company engaged in systematic "upcoding" of Medicare and Medicaid claims.

Nursing home hospice provider kept patients in hospice for years, overbilled for their care, prosecutors charge

Nursing home hospice provider kept patients in hospice for years, overbilled for their care, prosecutors charge

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An Illinois-based hospice provider overbilled Medicare and Medicaid by inappropriately designating nursing home residents as hospice patients, sometimes for years, according to federal charges announced Monday. The hospice administrator also took money for his personal accounts and obstructed justice, the prosecutors claim.

Nursing home therapy providers agree to pay $30 million whistleblower settlement

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Two nursing home therapy providers and a nursing home management company have agreed to pay $30 million to settle claims that they engaged in a kickback scheme, the U.S. Department of Justice has announced.

LTC insurance groups need a better strategy

LTC insurance groups need a better strategy

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What the long-term care insurance market could use right now is a healthy dose of capitalism. But it isn't going to happen.

Minnix: Medicaid managed care is inevitable, can benefit every community

Minnix: Medicaid managed care is inevitable, can benefit every community

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Providers and long-term care advocates need to embrace Medicaid managed care systems, which have the potential to drive improved health outcomes and bottom lines while helping providers serve those most in need, according to LeadingAge President and CEO Larry Minnix.

Government shutdown will not cripple long-term care, leaders say

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Long-term care providers will feel some effects but should not experience serious disruptions due to the shutdown of the federal government, according to prominent trade associations.

LTC commission meets for marathon hearing, receives public comments

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The Congressional Commission on Long-Term Care convened for its third hearing last week, focusing on how Medicare, Medicaid and long-term care insurance interact, and potential ways to strengthen these payment mechanisms. Over roughly eight hours, the 15 commission members heard from a total of 15 subject matter experts on four separate panels.

$1 billion available for projects to 'rapidly reduce' post-acute care costs, CMS announces

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The second round of the Health Care Innovation Awards is now underway, the Centers for Medicare & Medicaid Services announced Wednesday. CMS will distribute up to $1 billion to fund projects that aim to improve care while cutting costs for the Medicare and Medicaid programs.

HHS: Self-disclosure saves providers money in cases of Medicare and Medicaid fraud

HHS: Self-disclosure saves providers money in cases of Medicare and Medicaid fraud

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Long-term care providers who self-disclose potential Medicare and Medicaid fraud will likely benefit from lower repayment amounts, according to updated guidance released Wednesday. It is the first time HHS has explicitly acknowledged systematically imposing lower penalties for self-reported fraud.

State, CMS pair up on duals

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The Centers for Medicare & Medicaid Services and the state of Illinois are teaming up in a dual eligible payment demonstration.

Ryan's budget targets Medicare and Medicaid

Ryan's budget targets Medicare and Medicaid

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The House Budget Committee approved the latest spending plan from Chairman Paul Ryan (R-WI) in March. The vote was 22 to 17 along party lines.

Lawmakers should leave Medicare and Medicaid alone, Sebelius says

Lawmakers should leave Medicare and Medicaid alone, Sebelius says

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Medicare and Medicaid should not be significantly altered, because spending for these programs is trending downward and incentives tied to the programs are working, according to Health and Human Services Secretary Kathleen Sebelius.

$10 million therapy-provider kickback case may proceed, judge says

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A False Claims Act lawsuit involving a nursing home chain and therapy providers in Missouri can move forward, a federal judge has ruled. The case originated when a whistleblower alleged that a therapy company received more than $10 million in kickbacks as part of a scheme to overbill Medicare and Medicaid.

Deficit-reduction plan to gain $600 billion from lower provider payments and higher beneficiary premiums

Deficit-reduction plan to gain $600 billion from lower provider payments and higher beneficiary premiums

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The co-chairs of President Barack Obama's deficit reduction commission are promoting a way to achieve $600 billion in healthcare "savings" in a new version of their deficit reduction plan. Medicare and Medicaid cuts would be targeted over the next 10 years.

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